Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest
Authors: Caroline Hauw-Berlemont, Lionel Lamhaut, Jean-Luc Diehl, Christophe Andreotti, Olivier Varenne, Pierre Leroux, Jean-Baptiste Lascarrou, Patrice Guerin, Thomas Loeb, Eric Roupie, Cédric Daubin, Farzin Beygui, Florence Boissier, Nicolas Marjanovic, Luc Christiaens, Aurélie Vilfaillot, Sophie Glippa, Juliette Djadi Prat, Gilles Chatellier, Alain Cariou, Christian Spaulding, Christian Spaulding, Jean-Luc Diehl, Lionel Lamhaut, Christophe Andreotti, Alain Cariou, Olivier Varenne, Nicolas Deye, Georgios Sideris, Thomas Loeb, Marie Hauguel, Olivier Richard, Stéphane Legriel, Jean-Louis Georges, Lionel Nace, Bruno Levy, Batric Popovic, Guillaume Debaty, Carole Schwebel, Gérald Vanzetto, Michel Durand, Benoit Jardel, Fabienne Tamion, Eric Durand, Pierre Leroux, Jean-Baptiste Lascarrou, Patrice Guerin, David Hamdan, Pierre Asfar, Fabrice Prunier, Cyril Prieur, Hervé Delplancq, Ferhat Meziani, Patrick Ohlmann, Maud Carcaille, Clément Delmas, Meyer Elbaz, Benoit Simon, Sophie Marque, Pascal Goube, Nicolas Marjanovic, Florence Boissier, Luc Christiaens, Hubert Courcoux, Arnaud Gacouin, Guillaume Leurent, Said Laribi, Pierre-François Dequin, Denis Angoulvant, Eric Roupie, Damien Du Cheyron, Farzin Beygui, Denis Gonzalez, Pascal Motreff, Alix Aubry, Rami El Mahmoud, Jean-Michel Constantin, Caroline Hauw-Berlemont, Gilles Chatellier, Aurélie Villefaillot, Sophie Glippa, Youcef Sekour, Sabrina Boudif, Clémence De Oliveira-Bruyère, Axel Bouffier, Estelle Soueidi, Muriel Gernet, Ophélie Rogier, Mandy Nizard, Abel Grine, Malha Berrah, Anaïs Charles-Nelson, Karine Vu, Hajar Chouiki, Djennat Bousry, Iratxe Ciriza, Myriam Calvet, Juliette Djadi-Prat, Sandrine Katsahian, Aurélie Vilfaillot
Journal: JAMA Cardiology (2022)

<h3>Importance</h3> Although an emergency coronary angiogram (CAG) is recommended for patients who experience an out-of-hospital cardiac arrest (OHCA) with ST-segment elevation on the postresuscitation electrocardiogram (ECG), this strategy is still debated in patients without ST-segment elevation. <h3>Objective</h3> To assess the 180-day survival rate with Cerebral Performance Category (CPC) 1 or 2 of patients who experience an OHCA without ST-segment elevation on ECG and undergo emergency CAG vs delayed CAG. <h3>Design, Setting, and Participants</h3> The Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest (EMERGE) trial randomly assigned survivors of an OHCA without ST-segment elevation on ECG to either emergency or delayed (48 to 96 hours) CAG in 22 French centers. The trial took place from January 19, 2017, to November 23, 2020. Data were analyzed from November 24, 2020, to July 30, 2021. <h3>Main Outcomes and Measures</h3> The primary outcome was the 180-day survival rate with CPC of 2 or less. The secondary end points were occurrence of shock, ventricular tachycardia, and/or fibrillation within 48 hours, change in left ventricular ejection fraction between baseline and 180 days, CPC scale at intensive care unit discharge and day 90, survival rate, and hospital length of stay. <h3>Results</h3> A total of 279 patients (mean [SD] age, 64.7 [14.6] years; 195 men [69.9%]) were enrolled, with 141 (50.5%) in the emergency CAG group and 138 (49.5%) in the delayed CAG group. The study was underpowered. The mean (SD) time delay between randomization and CAG was 0.6 (3.7) hours in the emergency CAG group and 55.1 (37.2) hours in the delayed CAG group. The 180-day survival rates among patients with a CPC of 2 or less were 34.1% (47 of 141) in the emergency CAG group and 30.7% (42 of 138) in the delayed CAG group (hazard ratio [HR], 0.87; 95% CI, 0.65-1.15;<i>P</i> = .32). There was no difference in the overall survival rate at 180 days (emergency CAG, 36.2% [51 of 141] vs delayed CAG, 33.3% [46 of 138]; HR, 0.86; 95% CI, 0.64-1.15;<i>P</i> = .31) and in secondary outcomes between the 2 groups. <h3>Conclusions and Relevance</h3> In this randomized clinical trial, for patients who experience an OHCA without ST-segment elevation on ECG, a strategy of emergency CAG was not better than a strategy of delayed CAG with respect to 180-day survival rate and minimal neurologic sequelae. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02876458